Events on 27 September 2023

In recent years, healthcare policy has been moving towards the concept of patients being able to receive their pathology test results directly, it is likely that pathology providers may need to consider the communication of some laboratory test results directly to patients.

This is a very different group of people to what pathology providers are used to. Expansion of concepts such as reference intervals and what is significant need to be explored in the context of a more general audience.

Head and Neck cancers account for approximately 3% of new cancer incidence in the United Kingdom (UK). The use of ultrasound guided fine needle aspirations within head and neck ultrasound, has become a vital resource for cancer diagnosis. Historically, it was common for head and neck patients requiring a fine needle aspiration, to have an insufficient tissue sample from their initial examination, leading to patient re-call for repeat investigation. Subsequently, this negatively impacted upon the patient pathway by delaying cancer diagnosis and treatment.

The utilisation of Rapid on-site Evaluation (ROSE) has proven to transform the diagnostic pathway by negating the need for repeat examinations and therefore improving the rate at which patients are diagnosed and treated.

This presentation focuses on the achievements that have been accomplished through great collaborative working between radiology and cytology within head and neck and the consequent patient benefits. It includes a summary of how the ROSE service has grown at Royal Cornwall Hospital to include the Cornwall ROSE research pilot and the values this has brought to the population.

Case studies will be included as examples of where ROSE has been paramount to a swift diagnosis.

Additionally, the advantages and disadvantages of working with ROSE will be discussed from a sonographer's viewpoint, highlighting the potential pitfalls.



References

1. Head and neck cancers statistics | Cancer Research UK [Internet]. [cited 2023 May 26]. Available from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/head-and-neck-cancers#heading-Zero

2. Breeze J, Poller DN, Gibson D, Tilley EA, Cooke L, Soar E, et al. Rapid on-site assessment of specimens by biomedical scientists improves the quality of head and neck fine needle aspiration cytology. Cytopathology. 2013 Oct;n/a-n/a.

3. Medina Chamorro FM, Calle JA, Stein JE, Merchancano L, Mendoza Briñez AM, Pulido Wilches AA. Experience of the Implementation of Rapid On-Site Evaluation in Ultrasound-Guided Fine-Needle Aspiration Biopsy of Thyroid Nodules. Curr Probl Diagn Radiol. 2018 Jul;47(4):220–4.

4. Aly AK, Ali MA, Sharma A, Gubbels MA, Zhao X, Ahmed A, et al. Rapid On-site Evaluation (ROSE) for Fine Needle Aspiration of Thyroid: Is It Helpful? SciMed J. 2021 Mar 1;3(1):1–7.

The aim for this session is to carry on with the patient’s journey to final diagnosis. This presentation will discuss how the valuable material obtained from ROSE clinics are utilised in making a diagnosis and provide prognostic/treatment related information.

With the use of a number of examples, this presentation will illustrate how cytology impacts on patient’s management pathway, and how a standardised reporting system could be useful in unifying diagnostic pathways and performing future work on audit and quality improvement.

Finally, the strengths and limitations of head and neck cytology from the perceptive of a histo/cytopathologist will be discussed

Specialist portfolios: Updated, flexible and achievable

The requirement of extensive and complex testing on cytology samples is widely and routinely recognised. ROSE performed by scientists in the clinical setting provides a standardised, clinically effective, reproducible methodology for a variety of anatomical sites, some of which cytology is the only modality for sampling.

Real-time adequacy assessment eliminates the need for more invasive or repeat procedures by ensuring sufficient cell yield is obtained to conduct all the tests required for ancillary and molecular testing. This streamlines the patient pathway by reducing the referral to treatment time and reduces waiting list pressures, resulting in cost reduction for healthcare trusts and improved patient care and outcomes.

The presentation will explore the new IBMS ROSE qualification with the aim to inspire scientists to become skilled in ROSE.

Changing and expanding roles in Cellular Pathology

The aim of this presentation is to explain the growing importance of the use of cytopathology cell blocks in the diagnostic process and how this has evolved over recent years. In the past they were used as an 'extra' to the traditional Papanicolaou and Romanowsky stains whereas now they have an essential role in providing material for ancillary testing - immunocytochemistry and molecular studies.

The variety of methods of cell block preparation will be covered and why it is important that a department choses what method, or methods, are best suited to what is required from the finished result.

The cellular pathology of clots and cell blocks

Cell blocks from Diagnostic Cytopathology (DC) samples have always had value in the diagnostic process as a complement to the traditional cytology stains – Papanicolaou and Romanowsky. It has become more important to provide material for Immunocytochemistry to refine malignant diagnosis, and more recently, the use of molecular testing to aid in the choice of tailored chemotherapy regimens. If this information can be obtained from DC samples, which are less invasive than biopsy samples, the patient will benefit.

External Quality Assurance of cell block preparations has up to now been covered by the Tissue Diagnostic scheme. However, this is not entirely appropriate as cytopathology departments use a variety of cell block preparation methods and fixatives. The increase in number of cell block Haematoxylin and Eosin slides submitted to our evaluation service and the queries we receive regarding advice on best preparation methods suggested there was a need for a separate scheme for evaluation of cell blocks. A circulated survey indicated that there is a need for such a scheme. In response to this we performed 2 pilot studies which were well supported and successful, leading to the launch of the live scheme in April 2023.

This presentation covers the development of the scheme and the results of the 2 pilots. As an ongoing process the scheme will be able to garner information about ‘best methods’ and this can be passed on to laboratories experiencing problems and improve standards. UKNEQAS CPT is not just a ‘tick box’ service for UKAS, it is also an advisory service which aims to improve diagnostic practices.

Whats new in Diagnostic Cytology (Reporting systems; biomarker testing)